E D U CATI O N
ACA Annual Preventive Services:
Requirements, Client Motivation, & More
T
his article is a refresher for some and news to others. Bottom line is to encourage clients to seek basic preventive care as it will be FREE of copays and can be life saving too. The Affordable Care Act (ACA) significantly reformed the healthcare services available to children and adults. However, not all medical plan members know about the preventive services and medical exams available to them in California. As trusted client advocates, health insurance professionals must make sure their clients are aware of these free wellness checkups. Annual preventive services can benefit individuals in various ways, including: Following up on basic health markers • • Confirming general health and wellness • Staying up to date on immunizations • Encouraging more frequent appointments and exams Saving lives with early diagnosis • What is required to be covered on Wellness/Preventive Services Visits? Though specific policies and details may vary, most public and private healthcare plans cover annual preventive wellness exams at no extra cost. Kaiser of California, Anthem, and Blue Shield plans completely cover annual preventive services for individuals and select groups in California. [Editor’s note: Kaiser link goes to Northern California’s list of
20 | CALIFORNIA BROKER
preventive services, but we verified that it is exactly the same for the Southern California region.] Specific requirements and coverage limitations vary by healthcare provider and each client's needs. Most plans only cover wellness exams annually, so medical plan members who need more frequent visits may encounter obstacles. Even with complete coverage, your clients may still face challenges when scheduling and preparing for their annual wellness visits — often depending on their primary care provider (PCP). Why Is the Cost $0? The Affordable Care Act passed in 2010 mandates that states' health insurance plans must cover recommended preventive services, including annual wellness visits. Specifically, the Act eliminated cost-sharing practices that left patients with unaffordable medical fees. The ACA's measures make healthcare and long-term wellness more financially accessible CalBrokerMag.com
to everyone, including children, women, and impoverished communities. Now, families and individuals who previously couldn’t afford these services can receive them for free. The specific “recommended services’’ that are required to be covered for free vary. For example, the ACA specifies that comprehensive health risk assessments and fiveto-ten-year prevention plans should be covered during annual visits. However, the ACA doesn't require Medicare to cover select services recommended by the Health Resources and Services Administration (HRSA) for women and children. How Is the Preventive Services Visit Different From an Annual Physical? “Annual preventive services“is an umbrella term encompassing various types of ACA-covered services. They’re different than annual physicals, which examine patients' current health and medical history to assess current issues and future risks. Preventive wellness care often comprises many additional services. These free preventive services must be provided by a doctor within the patient’s plan network in California. Preventive services include the following items: Screenings for: Depression and mental health ● ● Hepatitis, HIV, and other STIs ● Tobacco use ● Tuberculosis
FEBRUARY 2024
